Sarcopenia in people living with HIV in Hong Kong: which definition correlates with health outcomes?

Introduction: Sarcopenia is an important clinical syndrome in older people living with HIV (PLWH). With a change to the Asia sarcopenia definition in 2019, we aimed to determine whether health outcomes were associated with different definitions of sarcopenia among Asian PLWH.

Methods: We performed a prospective cross-sectional study enrolling PLWH aged ≥35 years from January 2018 to November 2021. We defined sarcopenia by the Asia Working Group of Sarcopenia (AWGS) criteria in 2014 and 2019. AWGS-2014 included low muscle mass plus weak handgrip strength and/or slow gait speed. AWGS-2019 included low muscle mass plus low muscle strength or physical performance, while the presence of all defines severe sarcopenia. We measured appendicular skeletal muscle mass using dual-energy X-ray absorptiometry, handgrip strength, usual gait speed, five-time chair stand test and Short Physical Performance Battery. Correlations between each sarcopenia definition and health-related quality of life (using EQ-5D-5L and SF-36) and functional disability were determined.

Results: One hundred and fifty Asian PLWH were enrolled, 132 (88%) were male, mean age was 60±10 years, duration of HIV diagnosis was 13 (IQR 8-18) years and current CD4 count was 574 (IQR 362-762) cells/mm , 67 (45%) had multimorbidity, 64 (43%) had polypharmacy. Prevalence of sarcopenia by AWGS-2014, AWGS-2019 and severe sarcopenia was 17.3%, 27.3% and 18.0%, respectively. Age, education and polypharmacy were associated with sarcopenia. Sarcopenia (AWGS-2014) and severe sarcopenia were associated with mobility, physical functioning and physical component score (SF-36). All three criteria were associated with impaired instrumental activities of daily living (IADL). After age and sex adjustment, sarcopenia (AWGS-2014) (adjusted odds ratio/aOR 5.4, 95% confidence interval/CI 2.0-15.1) and severe sarcopenia (aOR 5.1, 95% CI 1.9-14.0) were associated with mobility and physical component score (SF-36) (β coefficients -5.3342, p = 0.022 and -5.412, p = 0.019). Sarcopenia (AWGS 2014) (aOR 5.2, 95% CI 1.7-16.2), sarcopenia (AWGS-2019) (aOR 4.5, 95% CI 1.5-13.1) and severe sarcopenia (aOR 3.5, 95% CI 1.1-10.9) were associated with impaired IADL in fully adjusted models.

Conclusions: In a sample of Asian PLWH, 17.3%, 27.3% and 18.0% had sarcopenia as defined by AWGS-2014, AWGS-2019 and severe sarcopenia, respectively. Sarcopenia by AWGS-2014 and severe sarcopenia correlated with parameters of poor health outcomes, while sarcopenia by AWGS-2019 correlated with functional disability.